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Title: Cost-effective and potential benefits in three-port hand-assisted laparoscopic sigmoidectomy
Authors: Natthawut Phothong
Thawatchai Akaraviputh
Vitoon Chinswangwatanakul
Asada Methasate
Atthaphorn Trakarnsanga
Mahidol University
Srinakharinwirot University
Keywords: Medicine
Issue Date: 1-Jan-2015
Citation: Journal of the Medical Association of Thailand. Vol.98, No.9 (2015), 864-870
Abstract: © 2015, Medical Association of Thailand. All Rights reserved. Objective: To demonstrate potential benefits of three-port hand-assisted laparoscopic sigmoidectomy (HALS) compared with open sigmoidectomy (OS) in terms of short-term outcomes and cost-benefit. Material and Method: A retrospective review of a database of cases that matched 100 sigmoid cancer patients treated with sigmoidectomy at the Department of Surgery, Siriraj Hospital was performed. Short-term outcomes and costs of treatment were collected and analyzed. Results: There were no differences in age, gender, body mass index, American Society of Anesthesiologists’ score, Charlson comorbidity index score, and previous surgery between OS and HALS groups. The three-port HALS group had significantly less blood loss (50 (5-400) mL vs. 120 (10-1,000) mL, p<0.001), faster time to regular diet (64.6±20.7 hours vs. 97.6±52.5 hours, p<0.001), and lower pain score (4.3±1.7 vs. 5.3±1.6, p = 0.008). The hospital-stay related cost was significantly lower in HALS group ($114 ($47-$789) vs. $190 ($57-$1,462), p<0.001). The low rate of infection was a major contributory factor (12% vs. 0%, p = 0.03). This was further emphasized in subgroup analysis of surgical site infection (SSI). While there are great benefits, the operative cost is higher in HALS. However, there is no significant difference in total costs of OS and HALS (US $2,243 ($1,321-$5,241) vs. $1,942 ($1,427-$11,910), p = 0.054). Conclusion: Simplified three-port HALS can be successfully performed with superior short-term outcomes and preserved oncologic outcomes. Cost-benefit advantage was highlighted especially in the area of high rate of SSI.
ISSN: 01252208
Appears in Collections:Scopus 2011-2015

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